Objective: to gain insight into the scale, nature, preventability and causes of adverse events in hospitalised older patients.Design: a three-stage retrospective, structured, medical record review study of 7,917 records of patients admitted in 21 Dutch hospitals in 2004.Main outcome measures: incidence, preventability, clinical process category, consequences and causes of adverse events in hospitalised patients of 65 years and older, compared with patients younger than 65.Results: adverse events and preventable adverse events occur significantly more often in older patients 6.9 (95 CI: 5.9-8.0) and 2.9 (95 CI: 2.3-3.7), respectively than in younger patients 4.8 (95 CI: 4.0-5.7) and 1.8 (95 CI: 1.3-2.4), respectively. In older patients, the adverse events were more often related to medication (20.1 versus 9.6) (P < 0.01). An exploration of the causes revealed that the inability to apply existing knowledge to a new and complex situation contributes more often to the occurrence of adverse events in older patients than in younger patients (36.4 versus 24.3) (P < 0.05).Conclusion: to reduce the number of adverse events in older patients in the future, more particular training of hospital staff in geriatric medicine is required, with a specific focus on medication.
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